Endometriosis

Endometriosis at a glance

  • Endometriosis occurs when the tissue of a woman’s endometrium, or uterine lining, grows on the outside of the uterus, sometimes in adjacent organs.
  • The leading theory for why endometriosis occurs is that during a woman’s menstrual cycle, flow occurs both vaginally as well as retrograde, meaning through the fallopian tubes into the abdominal cavity.
  • Endometriosis affects 6 to 10 percent of women of childbearing age, or about 5 million women in the United States, and probably affects many more women who don’t know they have it, according to the National Institutes of Health.
  • Many women do not show symptoms, but some women with endometriosis experience pain in the pelvis and abdomen.
  • Treatments for symptoms of endometriosis include surgery or medications, but there is not a known cure.

What is endometriosis?

Endometriosis can occur in women if the endometrial tissue that lines the uterus grows on the outside of the uterus, most commonly into organs near the uterus. For instance, the most common location for endometriosis is the lining of the uterus, or endometrium. Other locations include the deep pelvic sidewall, bladder and rectum.

Endometriosis may cause pelvic pain when a woman has a period and may cause uterine scarring. The endometrium, or the lining of the uterus, responds to hormonal changes, and menstrual bleeding is the result of decreasing progesterone levels at the end of the cycle. The abnormally located endometrial tissue also responds to these hormonal changes and therefore bleeds and causes symptoms and scarring.

Endometriosis primarily affects females age 15 to 45 who are of reproductive age. The cause of endometriosis is unknown. Researchers have found that estrogen can exacerbate endometriosis. Studies have shown that menopausal women with endometriosis generally experience a decrease in estrogen and stop having symptoms of endometriosis.

Symptoms of endometriosis

Pain and infertility are the two most commonly diagnosed symptoms of endometriosis. Many women with endometriosis do not experience any symptoms. Other symptoms commonly found in women with endometriosis are:

  • Pain in the pelvic region, heightened during menstruation.
  • Abnormal menstrual bleeding.
  • Difficulty becoming pregnant.
  • Ovarian cysts that do not go away.
  • Nausea, diarrhea or bloating.
  • Pain during or after sexual intercourse.
  • Pain when urinating or with bowel movements.

Endometriosis and fertility

Endometriosis can affect a woman’s fertility in many ways. Lesions or scars that develop from endometriosis can damage the reproductive organs.

Sometimes lesions can block the passage between a woman’s fallopian tubes, preventing the fallopian tubes from receiving an egg after ovulation. Lesions also can make it hard for the fertilized egg to pass through the fallopian tube to the uterus. Lesions can also impair the connection due to the tube or ovary being forced into an abnormal location in the woman’s body.

Endometriosis may affect a woman’s egg quality, but researchers have not discovered why it does.

Specific reasons for the cause of pain associated with endometriosis are unknown. Researchers found that unusually high levels of chemical messengers in women with endometriosis can heighten pain perception.

Diagnosis and treatment of endometriosis

The presence of endometriosis is generally discovered by a doctor since many women do not experience symptoms. Doctors can conduct an examination of a woman’s pelvic area if she is having symptoms or issues with becoming pregnant.

The physician will look for uncommon uterine positioning or abnormal cysts of the ovaries. Lesions can be seen in the vagina or cervix in some cases. Endometriosis can only be confirmed by a doctor through surgery in order to positively identify lesions. At the time of laparoscopy, the physician can either remove or ablate the endometriosis that is present.

After a woman is diagnosed with endometriosis, the doctor will evaluate the best course of treatment depending on if the symptoms are severe and if the woman is trying to become pregnant soon. No known cure exists for endometriosis, but treatment is available to help symptoms.

Doctors discuss the available forms of treatment with patients based on a woman’s symptoms and condition. Women with endometriosis usually can still carry a child depending on the severity of their condition.

Some treatments for endometriosis include:

Medications

Over-the-counter pain medication can help lessen pain caused by endometriosis. Birth control medication can reduce the amount of hormones in women, helping to lesson the symptoms of endometriosis. After medication is stopped, lesions usually present because the hormones are no longer suppressed.

Surgery

Laparoscopy is a minimally invasive surgery common for treating endometriosis. This surgery is best performed by a fertility specialist who will insert a narrow instrument to view the inner reproductive organs while surgically ablating lesions with a laser or removing the lesions. Laparoscopic surgery for women with endometriosis generally decreases pain in 60 to 80 percent of cases. For women wishing to conceive, laparoscopy is the preferred treatment since the patient can resume attempts at achieving pregnancy quicker than with medications.

As with any surgery, risks include reaction to anesthesia, damage to tissue and organs, blood loss or clotting, infection and pain.